Illustration Case I

A. B., a gentleman of rank and fortune, of the age of twenty-four years, had suffered for several months with occasional headach in the evening, which, at first, was generally relieved by a cup of strong coffee, and it therefore excited little or no attention. The pain, however, became more severe, and returned at shorter intervals; it sometimes attacked him during the morning, and was accompanied with sickness, by which a strong cpiantity of acid was ejected from his stomach, and the paroxysm was thus terminated. His person was strong and athletic, his countenance florid, and he underwent considerable exercise during the pursuit of the field amusements to which he was devoted: his appetite was therefore considerable, and the quantity of food which he was in the daily habit of taking, exceeded that which is generally sufficient for the most robust; he had never been in the habit of restricting his diet, because he had hitherto never felt any inconvenience from its excess. In the use of wine, however, he was temperate. The first professional communication which I received from him was in April 1824; he had then for some weeks been suffering from headach and sickness, and distressing symptoms of acidity.

I shall quote that part of his letter in which he describes the treatment he had received. "My medical attendant ordered me aloes and blue pill, and a potion made of gentian, bark, cascarilla, and liquor potassse. I found the prescriptions, word for word, in your Pharmacologia. I cannot however, say much for them, although the draught certainly does me some little good: he also ordered me lime-water, which is worth all the other put together: as for magnesia, I might as well eat powdered glass. What do you recommend next? I am regularly feeding on mutton, beef, etc, to the utter disgrace of vegetable diet." From this period he gradually grew worse; his attacks of headach increased in severity and frequency, and were rarely relieved until a great quantity of bile and intensely acid matter were thrown off the stomach: he grew rather thinner, but was by no means emaciated. I ordered him doses of carbonate of ammonia an hour after his dinner, and desired him to confine himself to an animal diet. He was well purged, and the action of the bowels kept up by small portions of a neutral salt. The stools were always natural in appearance.

He now found the slightest deviation from the prescribed diet to produce a headache; and when he prognosticated its approach from the presence of acid eructations, he was frequently enabled to avert it by a dose of ginger and carbonate of soda, which I had also prescribed for him. He says, "I have found it necessary to take your prescription once or twice a day, which has averted many a vile headach, as I always take it if I feel any symptoms of the generation of acid, such as heartburn, or an acid taste in my mouth. Having thus converted ' my stew-pan, vat, mill,' etc. into an apothecary's shop, I am much better than I have been, and have been nearly free from headach for the last fortnight, until yesterday, when I was in dock all day, and shall be so to-morrow. There is still, however, remaining to plague me, a sort of languor and laziness, which perhaps Dr. C.'s bitter prescription is intended to obviate, though it scarcely has such an effect. I wish the shooting season had arrived." I have introduced the relation of his feelings in his own words, because they will serve to convey a good idea of their nature and intensity, as well as of that hilarity and natural flow of spirits which constantly accompanied the progress of the disease in this highly-gifted and amiable young man.

In November I received from him a letter, of which the following is an abstract: "I find that the perpetual recurrence of my old headachs leaves me nothing for it but to turn them into a subject of amusement. I have been reading some speculations about muriatic acid in the human stomach, and would like very much to know what acid is in mine; and I wish you would put me in the way of testing it, for I can obtain any quantity. If it is a vegetable acid, how does it get into giblet soup, or salt beef, or fresh butter, cum multis aliis? If it is an animal acid, I know of none except the phosphoric, and I have no idea of making a match-box out of my viscera, so I vote at once it is not that. If it is a vegetable acid, how comes it that I may eat a dozen ripe peaches, and be none the worse for them? but woe to me if I eat a buttered muffin! Ergo, I infer that it is not wholly the acetic acid; and if not, what else can make sweet tea, or any thing like ale, beer, or porter, perfect poison to me? As for an animal acid, there is no poison for me like strong broth, or soup; ergo, there must be some villany in that. I was told, the other day, that baked meat would disagree with me, and I find this to be the case.

Now, for the muriatic acid, which I strongly suspect to be the one under which I suffer, for the action on my teeth, when I am sick, is too sharp for any thing less pungent - I find that if I eat salt meat, an acid is immediately formed in my stomach, and yet I can take any quantity of salt with my meat without being the worse for it: how can this happen? I am so often almost frantic with these headachs, that I am quite willing to devote myself to any experiment which you may choose to institute. The next curious, and to me unaccountable fact is, that if I eat any thing, even a mutton chop, between breakfast and dinner, I am sure to suffer from it, and that severely. About a week ago I went to Dublin, to transact some important business; and, lo, when the day came, my head felt as if it were nailed to my pillow. They sent for Mr. Crampton, the surgeon-general, who greatly approves of the carbonate of soda and ginger, and added to it five grains of rhubarb. This very day I have taken, at three times, thirty grains of the soda, which gives a very temporary relief. 1 am particular in my diet, and take no drink but water; still, in spite of these precautions, I have a very had headach once a week, and a moderate one or two besides.